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Research Article

Effects of cinnamon on perineal pain and healing

of episiotomy: a randomized placebo-controlled trial
Azam Mohammadi1, Sakineh Mohammad-Alizadeh-Charandabi2, Mojgan Mirghafourvand3,
Yousef Javadzadeh4, Zahra Fardiazar5, Fatemeh Effati-Daryani1
1. Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences,
Tabriz, Iran
2. Iranian Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
3. Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
4. Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
5. Women Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

BACKGROUND: Analgesic and wound-healing effects of cinnamon, a widely used spice, have
been shown in laboratory rats. However, we found no human studies in this area.
OBJECTIVE: The aim of this study was to assess the effect of cinnamon on perineal pain and
healing of episiotomy incision.
DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: In this double-blind, randomized,
placebo-controlled trial, 144 postpartum women were allocated into two groups, using stratified
block randomization, 1 h after completion of episiotomy repair. They received cinnamon or placebo
ointment, 2 mL every 12 h for 10 d.
MAIN OUTCOME MEASURES: Perineal pain and wound healing were assessed using visual
analogue scale (0-10) and Redness, Edema, Ecchymosis, Discharge, Approximation scale (0-15),
respectively. General linear model was used to compare the groups on the outcomes adjusted for
baseline values and stratified factors.
RESULTS: Follow-up rate was 100% up to the 8 h time point in both groups, and 86% (62 of 72)
in the cinnamon group and 85% (61 of 72) in the placebo group at day 10-11 after delivery. Pain
score in the cinnamon group was significantly lower than that in the placebo group at (41) h
(adjusted difference: -0.6, 95% confidence interval: -1.0 to -0.2) and (81) h (-0.9, -1.4 to -0.3)
after intervention, and on the 10-11th day after delivery (-1.4, -2.0 to -0.7). Also the cinnamon
group showed significantly more improvement than the control group in healing score at (81) h
(-0.2, -0.4 to -0.04) and the 10-11th day after delivery (-1.6, -2.0 to -1.1).
CONCLUSION: Cinnamon can be used for reducing perineal pain and improving healing of episiotomy
incision.
KEYWORDS: Cinnamomum zeylanicum; episiotomy; postpartum period; pain; wound healing;
randomized controlled trial
http://dx.doi.org/10.1016/S2095-4964(14)60025-X
Mohammadi A, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Javadzadeh Y, Fardiazar
Z, Effati-Daryani F. Effects of cinnamon on perineal pain and healing of episiotomy: a randomized
placebo-controlled trial. J Integr Med. 2014; 12(4): 359-366.
Received February 3, 2014; accepted March 11, 2014.
Correspondence: Sakineh Mohammad-Alizadeh-Charandabi; Tel: +98-9143136276; E-mail: alizades@
tbzmed.ac.ir, smoalch@yahoo.com

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1 Introduction
Episiotomy is the most common obstetric intervention
in the world. Its prevalence has been reported to be 43%
to 100% in primiparous women in Asia[1] and up to 100%
in some hospitals of major cities in Iran[2].
Prevalence of perineal pain in people with episiotomy
is about fourfold compared to those with no episiotomy[3].
Perineal pain adversely affects different aspects of womens
life including lactation, child care and daily chores [4].
Postpartum is a sensitive time when mothers must juggle
their own recovery while dealing with the needs of their
newborns. Effective pain relief is a major aspect of postpartum
care that can positively affect womens life[5-7].
There are several common methods used for reducing
pain and accelerating the episiotomy-healing process[3].
Nonsteroidal anti-inflammatory drugs are among the typical
medications used to reduce episiotomy pain[4], though they
may cause some side effects such as peptic ulcers[8]. Betadine
(Iodine) is also commonly used to prevent infection and
help with healing of the episiotomy wound. However,
various studies show that it has no significant effect on
microorganism-reduction[9]. Many women find the current
available methods unsatisfactory and are looking for other
effective and safe options.
Only a few studies have been conducted on the care of
this very common wound[10]. Some studies have examined
the effects of herbal remedies such as lavender[11], olive
oil[12], or curcumin[13] on episiotomy pain and healing.
However, definitive effects of these methods have not
been verified through clinical trials, and more extensive
studies are still required in this area[3].
Cinnamon is a widely used spice worldwide[14]. It has been
found to have numerous properties including anti-inflammatory, antioxidant, and antimicrobial[15]. Analgesic[16,17] and
wound-healing[18] effects of its ethanol extract have been
shown in laboratory rats. Also, no significant adverse effects of cinnamon have been found in human studies[19].
Considering the above-mentioned evidence on the possible
efficacy and safety of cinnamon extract, plus the lack of
any human studies on its analgesic and healing effects, this
study was conducted to determine the effects of a 10-day
application of 2% cinnamon extract ointment on episiotomy
wound. The primary outcomes involved reducing perineal
pain and accelerating healing of the episiotomy wound;
secondary outcomes measured consumption of other analgesics,
as compared to the placebo group.
2 Materials and methods
2.1 Study design, participants and setting
This study was a randomized, double-blind, placeboJuly 2014, Vol.12, No.4

controlled trial. Women aged 18 to 40 years with parity

1-3 who had vaginal birth with episiotomy were included
in the study. Exclusion criteria were: being illiterate; having
no access to a phone line (for follow-up); use of drugs or
psychotropic substances; gestational age of less than 37 or
more than 42 weeks; history of chronic physical or mental
diseases that may interfere with healing; following a special
diet; long-term (over 18 h) rupture of amniotic sac; severe
anemia (haemoglobin less than 70 g/L at admission); history
of hypersensitivity to certain drugs; extension of episiotomy
(tears of grade 3 or 4); and operative delivery.
Recruitment was done at two hospitals affiliated to the
Tabriz University of Medical Sciences (Alzahra, Taleghani,
Iran), and one hospital affiliated to the Social Security
Organization (29 Bahman). The hospitals are the only
public maternity facilities in Tabriz and have the highest
number of clients for vaginal delivery services among all
centers in Tabriz, Iran.
In these hospitals, episiotomy is usually performed in
more than 90% of the first vaginal deliveries, and 70%
of the second and third deliveries. Episiotomy incision and
repair is often done by midwifery students, obstetrics
assistants, and senior medical students, and in some cases
by employed midwives. Cephalexin (500 mg, oral) is routinely
administered four times a day for 6 d after delivery. In all
the three medical centers, non-continuous stitches are used to
repair episiotomy.
2.2 Allocation and intervention
Allocation sequence was determined by block randomization
with block sizes of 4 and 6, and allocation ratio of 1:1 using
a computer-generated randomization schedule with stratification for center (three centers) and parity (two strata:
first and second or third). Sequentially numbered, opaque,
sealed envelopes of the same shape and size containing
cinnamon or placebo ointment were used to conceal the
allocation and to maintain blinding. Every package contained
one 40 g cinnamon or placebo tube with no label on it.
The packages and allocation sequence were prepared
by a person who was not involved in the recruitment, data
collection and data analysis. Therefore, the investigators
and participants were unaware of the type of ointment
given to every participant (double blinding).
After obtaining written informed consent from eligible
women at the first stage of delivery, the investigator (first
author, AM) attended at bedside of every participant to
record details of delivery and episiotomy procedure in a
checklist. The person in charge of delivery was requested
to use no disinfectant on the perineal area. The first part
of the questionnaire (socio-demographic and reproductive
characteristics) was completed based on the file documentation and interview with the participants. The investigator
measured episiotomy incision length using a sterile tool
and transferring it onto a ruler. After baseline assessment

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of perineal pain and wound-healing which was done about

1 h after completion of the repair, the package containing
the ointment was made available to the participant.
Participants were taught verbally and were given a
written pamphlet on how to take care of the episiotomy
incision (including advice on personal hygiene, sexual
relationship, and nutrition) and how to use their medication.
They were instructed to wash hands and the perineum
thoroughly and dry it with a clean tissue every time before
using the ointment, then put a length of a finger bone of
ointment (approximately 2 cm) on the stitch area after
1-2 min using a sterile pad. This procedure was to be
repeated twice daily, at 12-hour intervals (2 h) for 10 d.
To ensure that the participants understood the directions,
the first ointment application was carried out by the participant
about 1 h after completion of episiotomy repair, in the
presence of the investigator.
We also gave the participants 10 mefenamic acid capsules,
each 400 mg and a diary to record the ointment use, any
analgesics taken and any side events during the 10-11 d
after delivery. We asked them to try to take the given capsules
for pain relief only if needed. Moreover, they were asked
to return to the hospital 10-11 d after delivery for a
re-assessment and to deliver the empty tubes of the drugs.
2.3 Ointment preparation
In the Industrial Pharmacy Laboratory of the Tabriz
University of Medical Sciences and under direct supervision
of the pharmacist from our research team, cinnamon bark
was soaked in 70% hydroalcoholic solution and stirred
on a shaker for 72 h. After this period, the hydroalcoholic
extract was passed through a paper filter. The remaining
pulp was shaken again in the hydroalcoholic solution for
another 72 h and its hydroalcoholic extract was separated
and added to the previous extract. The obtained extract
was placed in the rotary evaporator until all the solvents
were removed and a dry powder was left.
Dried extract was kept sealed and away from light and
humidity until preparation of ointment. To prepare the
ointment (2%, w/w), appropriate amounts of extract were
levigated with a suitable amount of paraffin. Then, 0.1%
(w/w) of methyl paraben and 0.02% (w/w) of propyl
paraben were added as preservatives, and stirred. An
appropriate amount of eucerin was added, and stirred in
a planetary-type stirring device. Next, to homogenize the
final weight obtained, a three-cylinder grinding device
was used. All of the ointment was passed through this
grinder and filled into 40 g tubes using an ointment filling
machine under aseptic conditions. The tubes were then
packed by a packing machine. Prepared formulations were
kept at 5 C and 40 C for a period of two months in order
to assay their physical stability based on their appearance.
After this period, there were not any signs of instabilities
such as colour change, phase separation or odour change.
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The placebo ointment was also prepared from the same

materials except cinnamon extract, and packed into same
tubes. The ointments were identical in color, shape and
size.
2.4 Outcomes
Primary outcomes of this study were perineal pain intensity score and healing score of episiotomy incision.
Perineal pain was recorded before the intervention (1 h
after completion of repair), (41) h, and (81) h after first
ointment administration and 10-11 d after delivery, using
the visual analogue scale (VAS). Wound-healing was
assessed before intervention, at (81) h after first ointment
administration and 10-11 d after delivery using the Redness,
Edema, Ecchymosis, Discharge, Approximation (REEDA)
scale. Secondary outcomes were components of REEDA,
number of analgesics (mefenamic acid) taken during the
10 d after delivery, resuming normal daily activities within
5 d postpartum, and side events.
VAS is a validated scale length of 10 cm with 0 (no
pain) in the one end and 10 (the maximum imaginable
pain) on the other end. This scale is widely used in
pain-related studies and its validity and reliability have
been confirmed [20]. REEDA scale consists of 5 items
(redness, edema, ecchymosis, discharge, and approximation). Each item is rated on a scale of zero to three. Sum
of the scores (possible score range of 0 to 15) determines
the overall healing score; the lesser score, the better
healing[21].
Pain intensity was determined by the participants on
the relevant ruler and healing status by the investigator
through direct observation of episiotomy incision in lithotomic
position. Potential side effects of the ointment were investigated
twice on the phone over 10 d in addition to assessment at
other follow-up visits.
2.5 Sample size and statistical analysis
Considering 5.0 for mean and 1.5 for standard deviation
of pain intensity based on results of a study carried out in
a similar setting in Iran[11], a two-sided significance level
of 0.05, power of 0.80 and a 15% possible dropout rate,
the required sample size was calculated to be 71 participants
per group to detect at least 20% reduction in mean pain
intensity due to the intervention.
Normality of the quantitative variables by the groups
was confirmed using skewness and kurtosis. Independent
t-test was used for comparison of the baseline scores and
general linear model with repeated measures for comparison
of the follow-up scores adjusted for the baseline values
and stratified factors (hospitals and nulliparity/multiparity).
Sidak was used for multiple comparisons of the scores
between the groups. Mann-Whitney U test was used for
comparing mean rank of the groups in terms of REEDA
components. Data analysis was carried out by SPSS for
Windows 14.0 (SPSS Inc., Chicago, IL, USA). P values

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of less than 0.05 were considered statistically significant.

2.6 Ethical approval
This research project was approved scientifically by the
Research Committee of the Tabriz University of Medical
Sciences and ethically by the ethic committee of the university
(Ethic code: 91157). Also, it was registered in the Iranian
registration system with IRCT201211303706N18 on 13
December 2012 before starting participant recruitment.
3 Results
3.1 Recruitment and follow-up
Participant recruitment was carried out from 20 February to
31 October, 2013 and follow-up ended on 11 November, 2013.
A total of 233 patients were initially screened, but 86 were
excluded because of ineligibility. Three patients refused to
participate due to high work load and inability to use the
ointment regularly. Thus, 72 participants were allocated
into each group. Follow-up rate was 100% up through the
8-hour mark, and at 10-11 d after delivery was 86% in the
cinnamon group and 85% in the placebo group (Figure 1).
3.2 Participant characteristics
More than half (60%) in each group were primiparous.
The groups were similar in terms of socio-demographic

and reproductive characteristics. Mean age of the participants was (26.4 4.9) years. About one third (35%)
reported that their income did not suffice their expenses.
A majority of the participants were Azari (89%), housewives
(94%), and lived in the city (88%). Mean duration of episiotomy incision repair was (31.1 16.7) min in the cinnamon
group and (35.6 18.0) min in the placebo group. Mean
interval between episiotomy incision and start of repair
was (15.3 6.6) min in the cinnamon group and (17.4
7.2) min in the placebo group (Table 1). Most of participants
in both cinnamon (90%) and placebo (80%) groups had
used toilet at squatting position.
3.3 Primary outcomes
Mean pain intensity at baseline was 5.0 1.8 in the
cinnamon group and 4.6 2.0 in the placebo group. At all
three follow-up assessments, intensity of pain in the cinnamon
group was significantly lower than that in the placebo
group. Adjusted pain score difference (MD) was -0.6 (95%
confidence interval (CI): -1.0 to -0.2) at (41) h, -0.9
(95% CI: -1.4 to -0.3) at (81) h, and -1.4 (95% CI: -2.0 to
-0.7) at 10-11 d postpartum (Table 2). Compared to baseline,
pain intensity reduction at (41) h, (81) h, and (10-11) d
postpartum was 16%, 26%, and 76% in the cinnamon group
and 2%, 4%, and 43% in the placebo group, respectively.

Figure 1 Flowchart of the study

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Table 1 Socio-demographic and reproductive characteristics of the participants
Characteristics

Cinnamon group (n=72)

Age (years)
Education (years)
2

Placebo group (n=72)

27.35.1

25.74.5

9.93.8

9.43.7

Body mass index (kg/m )

25.03.2

24.63.7

Duration of second stage of labor (min)

39.123.3

39.526.5

8.23.5

9.25.1

15.36.6

17.47.2

3.40.7

3.40.8

Duration of third stage of labor (min)

Interval between episiotomy incision and start of repair (min)
External length of episiotomy (cm)
Length of episiotomy repair (min)
Weight of newborn (g)

31.116.7

35.618.0

3 164503

3 294507

34.61.3

34.81.3

Urban resident

Neonatal head circumference (cm)

62 (86.1%)

64 (88.9%)

Job (employed)

6 (8.4%)

3 (4.2%)

Economy status
Income upper than spent
Income equal spent

2 (2.8%)

6 (8.3%)

45 (62.5%)

40 (55.6%)

Income lower than spent

25 (34.7%)

26 (36.1%)

Placenta exit (spontaneous)

69 (95.8%)

67 (93.1%)

Data indicate mean standard deviation or number (%).

Table 2 Comparison of pain and healing status between the study groups at different time points
Pain (VAS, 0-10)
Group

Baseline

Healing status (REEDA scale, 0-15)

(41) h after (81) h after 10-11 d after

intervention intervention
delivery

Baseline

(81) h after 10-11 d after

intervention
delivery

Cinnamon

5.01.8

4.21.6

3.71.8

1.21.6

3.41.6

3.51.4

1.61.3

Placebo

4.62.0

4.51.7

4.41.7

2.62.1

3.21.5

3.51.4

3.01.6

Mean difference (95% CI)

0.5 (-0.1
to 1.1)

-0.6 (-1.0
to -0.2)

-0.9 (-1.4
to -0.3)

-1.4 (-2.0
to -0.7)

0.2 (-0.2
to 0.7)

-0.2 (-0.4
to -0.04)

-1.6 (-2.0
to -1.1)

P value

0.12

0.003

0.002

<0.01

0.33

0.01

<0.01

Data indicate mean standard deviation; number of participants was 72 in each group at baseline, (41) h and (81) h and 62 in the
cinnamon group and 61 in the placebo group at the 10-11 d.
Mean difference for the baseline comparison using independent t-test, adjusted mean difference (adjusted by the baseline values and
stratified factors (centers and parity)) for the follow-up comparisons using univariate general linear model.
VAS: visual analogue scale; REEDA: Redness, Edema, Ecchymosis, Discharge, Approximation; CI: confidence interval.

Mean baseline REEDA score was 3.4 1.6 in the cinnamon

group and 3.2 1.5 in the placebo group. The score of the
cinnamon group was significantly lower than that of the
placebo group at both of the follow-up assessments: -0.2
(95% CI: -0.4 to -0.04) at (81) h and -1.6 (95% CI: -2.0 to
-1.1) on 10-11 d postpartum (Table 2). Compared to baseline,
REEDA score reduction was 53% in the cinnamon group
and 6% in the placebo group at 10-11 d postpartum.
In the repeated measurement test, both overall pain
intensity score (-0.9 (95% CI: -1.36 to -0.53)), and overall
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healing score (-0.9 (95% CI: -0.6 to -1.16)) after intervention

were significantly lower in the cinnamon group as compared
to the placebo group (P<0.01) (Figures 2 and 3).
3.4 Secondary outcomes
There was no significant difference (P>0.05) between
the groups at baseline and the (81) h in terms of REEDA components except wound approximation (P=0.02).
During 10 d postpartum, in the intervention group vs the
placebo group, there was no redness (39% vs 15%), no
edema (71% vs 34%), no ecchymosis (95% vs 82%), no

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Figure 2 Mean score of pain intensity in the cinnamon and

placebo groups at different time points

serosanguinous discharge (scored 2) and two others had

bloody purulent discharge (scored 3), while no one in the
cinnamon group had such discharges. Due to existence of
significance difference at baseline between the groups in
terms of approximation, we also compared change score
of this component on day 10-11 (in relation to the baseline),
which was also significantly better in the cinnamon group
(P=0.025).
Mean number of mefenamic acid intake over 10-11 d
postpartum was 4.2 capsules in the cinnamon group and
4.4 capsules in the placebo group, with no statistically
significant difference (P=0.8). Mean number of other analgesics
(diclofenac suppository, acetaminophen codeine, and
ibuprofen) in the cinnamon group was 16 and in the placebo
group was 18, with no significant difference between the
groups (P=0.6). Seven patients (10%) in the cinnamon
group and 15 (21%) in the placebo group had used betadine
for washing the perineal area as well.
Forty-six participants (74%) in the cinnamon group
and 29 (48%) in the placebo group reported that they had
resumed their normal daily activities (household chores,
cooking and child care) within 5 d postpartum, and the
difference between the groups was statistically significant
(P=0.003).
One patient in the cinnamon group and five in the placebo
group had partial dehiscence of episiotomy. None of the
patients had dehiscence severe enough to require restoration.
Antibiotics were administered for the patients on the 10-11 d
visit and these patients were followed up until full recovery.
No side effects were reported by the participants in either group.
4 Discussion

Figure 3 Mean score of healing status in the cinnamon and

placebo groups at different time points

discharge (13% vs 23%) and complete closure (65% vs

39%). Wound-healing scores in the cinnamon group was
significantly less than those in the placebo group in 4 of
5 components (P<0.01 for redness and edema, P=0.021
for ecchymosis, and P=0.003 for approximation). The
difference between groups was not statistically significant
(P=0.1). However, in the placebo group two patients had
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Our study results showed that use of cinnamon ointment

on episiotomy incision for 10 d reduced intensity of perineal
pain and improved healing of the incision with no significant
side effects.
According to a review of the literature, this study was
the first clinical trial on the anti-inflammatory and analgesic
properties of cinnamon for wound-healing in humans. Previous
studies on laboratory rats also indicated analgesic[16] and
healing properties of cinnamon extract. Some experts
believe that cinnamon increases epithelization, reduces
oxidative stress and improves wound-healing with its anti-microbial and antioxidant properties[18,22].
Based on a review study, cinnamon is recommended for
the treatment of many diseases such as diabetes, hypertension,
and cardiovascular diseases[14]. Three main compounds in
cinnamon include eugenol, cinnamaldehyde, and linalool,
which make up about 80% of its composition[23]. Eugenol
may affect inflammation through reducing prostaglandin
biosynthesis; it also has a numbing effect. Cinnamaldehyde
also has anti-inflammatory properties[24]. Linalools analgesic

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and anti-inflammatory effects work via reducing nitric oxide

and activating analgesic paths of cholinergic and glutamatergic
compounds[25,26]. Cinnamon extract can also reduce inflammation by its polyphenol compounds[27].
A 2012 study showed that lavender essence has similar
effects on postpartum perineal pain, probably due to the
presence of linalool and trephine compounds in lavender,
similar to cinnamon compounds[11]. In a study, the positive
effect of turmeric ointment was attributed to its curcumin
compound[28]. It is believed that this substance asserts its
effect through inhibition of cyclooxygenase and reduction
of nitric oxide[29], which is similar to linalools function in
cinnamon.
In the present study, the cinnamon groups decreases in
redness and presence of seroanguinous or purulent secretion
on the 10th day were probably due to cinnamons anti-inflammatory[27] and antimicrobial[14] properties.
Wound dehiscence in the present study (1 case in the
cinnamon group and 5 cases in the placebo group) was
slightly more common than what is expected based on
international references, i.e., 0.1% to 2.1%[30]. However, it
was slightly less than what is found in the study conducted
in Arak-Iran, in which the wound dehiscence was 3% in
the group using a sitz bath of lavender oil and 8% in the
group using betadine[31]. A possible reason for this slightly
higher dehiscence might be related to insufficient skills of
the students who performed most episiotomy procedures
in the hospitals. In the present study, repair duration was
relatively long (35 min) which is probably accompanied
with more manipulation of the incision, and may adversely
affect wound healing.
We have no possibility to biopsy for follow-up of the
wound due to financial limitations. Although in this study
loss to follow-up at the 10th day was relatively high (15%),
given that both groups had similar numbers and reasons of
withdrawals (even higher frequency of withdrawals in the
cinnamon group due to expressing improvement), the loss
to follow-up probably has not affected the results in any
significant way. Considering lack of previous studies on
human wounds, a low dose of cinnamon (2%) was used in
the present study.
This is the first human study on the analgesic and healing
effects of cinnamon. Similar results have been shown
in previous studies on non-human research subjects [18].
More human studies carried out in other settings would be
valuable to confirm these effects on episiotomy and other
wounds. This study does not have enough statistical power
to identify safety of the intervention, which should be
assessed in other trials on higher numbers of participants
or in meta-analysis of primary studies. Also, because no
particular side effects were reported in this and in other
studies with higher doses (3%) on laboratory rats[18,22],
future studies should be conducted with various doses of
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cinnamon to identify the most effective dose.

5 Conclusion
Results of this study indicate that application of 2%
cinnamon ointment on episiotomy incisions has a significant
effect in decreasing perineal pain and accelerating healing
of the incision.
6 Competing interests
The authors declare that they have no competing interests.
REFERENCES
1

Graham ID, Carroli G, Davies C, Medves JM. Episiotomy

rates around the world: an update. Birth. 2005; 3(23): 219223.
2 Khani S, Zare K. The frequency of episiotomy and its related
factors. Iran J Nurs. 2012; 24(74): 45-52. Persian with abstract
in English.
3 Francisco AA, de Oliveira SMJV, de Oliveira Santos J, da
Silva FMB. Evaluation and treatment of perineal pain in
vaginal postpartum. Acta Paul Enferm. 2011; 24(1): 94100.
4 East CE, Sherburn M, Nagle C, Said J, Forster D. Perineal
pain following childbirth: prevalence, effects on postnatal
recovery and analgesia usage. Midwifery. 2012; 28(1): 9397.
5 Signorello LB, Harlow BL, Chekos AK, Repke JT. Postpartum
sexual functioning and its relationship to perineal trauma:
a retrospective cohort study of primiparous women. Am J
Obstet Gynecol. 2001; 184(5): 881-890.
6 Eisenach JC, Pan PH, Smiley R, Lavandhomme P, Landau R,
Houle TT. Severity of acute pain after childbirth, but not type
of delivery, predicts persistent pain and postpartum depression.
Pain. 2008; 140(1): 87-94.
7 Gutke A, Lundberg M, stgaard HC, berg B. Impact of
postpartum lumbopelvic pain on disability, pain intensity,
health-related quality of life, activity level, kinesiophobia,
and depressive symptoms. Eur Spine J. 2011; 20(3): 440448.
8 Simon LS. Nonsteroidal anti-inflammatory drugs and their
risk: a story still in development. Arthritis Res Ther. 2013;
15(Suppl 3): S1.
9 Tork Zahrani SH, Amirali Akbari S, Valaei N. Comparison
of the effect of betadine and water in episiotomy wound
healing. Feyz J Kashan Univ Med Sci. 2002; 5(20): 80-85.
Persian with abstract in English.
10 Masoumi Z, Keramat A, Hajiaghaei R. Systematic review
on effect of herbal medicine on pain after perineal episiotomy
and cesarean cutting. J Med Plants. 2012; 10(40): 1-16.
11 Sheikhan F, Jahdi F, Khoei EM, Shamsalizadeh N, Sheikhan
M, Haghani H. Episiotomy pain relief: use of Lavender oil
essence in primiparous Iranian women. Complement Ther
Clin Pract. 2012; 18(1): 66-70.
12 Behmanesh F, Aghamohammadi A, Zeinalzadeh M, Khafri

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14

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17

18
19

20

21

S. Effects of olive oil sitz bath on improvement of perineal

injury after delivery. Koomesh. 2013; 14(3): 309-315. Persian
with abstract in English.
Vardanjani SAE, Shafai FS, Mohebi P, Deyhimi M, Delazar
A, Ghojazadeh M, Malekpour P. Wound healing benefits of
curcumin for perineal repair after episiotomy: results of an
Iranian randomized controlled trial. Life Sci J. 2010; 9(4):
5536-5541.
Ranasinghe P, Pigera S, Premakumara GA, Galappaththy P,
Constantine GR, Katulanda P. Medicinal properties of true
cinnamon (Cinnamomum zeylanicum): a systematic review.
BMC Complement Altern Med. 2013; 13: 275.
Jakhetia V, Patel R, Khatri P, Pahuja N, Garg S, Pandey A,
Sharma S. Cinnamon: a pharmacological review. J Adv Sci
Res. 2010; 1(2): 19-23.
Arzi A, Sarkaki A, Aghel N, Nazari Z, Saeidnejad S. Study
of analgesic effect of hydroalcoholic extract of cinammom.
Sci Med J. 2011; 10(3): 271-279. Persian with abstract in
English.
Dashti Rahmatabadi MH, Vahidi Merjardi AR, Pilavaran AA,
Farzan F. Effect of cinnamon extract on formalin induced
pain in rat. J Shaheed Sadoughi Univ Med Sci. 2009; 17(2):
190-199. Persian with abstract in English.
Kamath JV, Rana AC, Chowdhury AR. Pro-healing effect of
Cinnamomum zeylanicum bark. Phytother Res. 2003; 17(8):
970-972.
Ranasinghe P, Jayawardena R, Galappaththy P, Constantine GR,
de Vas Gunawardana N, Katulanda P. Response to Akilen
et al. Efficacy and safety of true cinnamon (Cinnamomum
zeylanicum) as a pharmaceutical agent in diabetes: a systematic
review and meta-analysis. Diabet Med. 2013; 30(4): 506507.
Lara-Muoz C, De Leon SP, Feinstein AR, Puente A, Wells CK.
Comparison of three rating scales for measuring subjective
phenomena in clinical research. I. Use of experimentally
controlled auditory stimuli. Arch Med Res. 2004; 35(1): 4348.
Hill PD. Psychometric properties of the REEDA. J Nurse
Midwifery. 1990; 35(3): 162-165.

22 Farahpour MR, Habibi M. Evaluation of the wound healing

activity of an ethanolic extract of Ceylon cinnamon in mice.
Vet Med (Praha). 2012; 57(1): 53-57.
23 Chericoni S, Prieto JM, Iacopini P, Cioni P, Morelli I. In vitro
activity of the essential oil of Cinnamomum zeylanicum and
eugenol in peroxynitrite-induced oxidative processes. J Agric
Food Chem. 2005; 53(12): 4762-4765.
24 Zarifkar A, Shandaryan HMS, Mokhtary M, Ay J. An evaluation
on antinociceptive effects of eugenol by formalin test in
rats. J Dent Med. 2003; 16(1): 61-67. Persian with abstract
in English.
25 Peana AT, Marzocco S, Popolo A, Pinto A. (-)-Linalool
inhibits in vitro NO formation: probable involvement in the
antinociceptive activity of this monoterpene compound.
Life Sci J. 2006; 78(7): 719-723.
26 Peana AT, DAquila PS, Chessa ML, Moretti MD, Serra G, Pippia
P. (-)-Linalool produces antinociception in two experimental
models of pain. Eur J Pharmacol. 2003; 460(1): 37-41.
27 Hong JW, Yang GE, Kim YB, Eom SH, Lew JH, Kang H.
Anti-inflammatory activity of Cinnamon water extract in vivo
and in vitro LPS-induced models. BMC Complement Altern
Med. 2012; 12(1): 237-245.
28 Golmakani N, Motlagh ER, Tara F, Assili J, Shakeri MT.
The effects of turmeric (Curcuma longa L) ointment on
healing of episiotomy site in primiparous women. Iran J
Obstet Gynecol Infertil. 2009; 11(4): 29-39. Persian with
abstract in English.
29 Lee SK, Hong CH, Huh SK, Kim SS, Oh OJ, Min HY, Park
KK, Chung WY, Hwang JK. Suppressive effect of natural
sesquiterpenoids on inducible cyclooxygenase (COX-2) and
nitric oxide synthase (iNOS) activity in mouse macrophage
cells. J Environ Pathol Toxicol Oncol. 2002; 21(2): 141-148.
30 Williams MK, Chames MC. Risk factors for the breakdown
of perineal laceration repair after vaginal delivery. Am J
Obstet Gynecol. 2006; 195(3): 755-759.
31 Vakilian K, Atarha M, Bekhradi R, Ghebleh F, Hatami Z, Ceraj
A. The effect of lavender in care of postpartum episiotomy
wounds. J Shahrekord Univ Med Sci. 2008; 10(3): 63-69.
Persian with abstract in English.

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